Questions_and_Answers_-_PBM_Solicitation_1605DC-18-R-00020.pdf

Questions and Answers Submitted For

Pharmacy Benefits Management (PBM) Services

Request for Proposal (RFP)

Department of Labor (DOL) Office of Workers’ Compensation Programs (OWCP)

Solicitation Number 1605DC-18-R-00020

1. QUESTION:

Is this a new requirement, or is there an Incumbent Contractor?

If there is an Incumbent Contractor, please provide the following information:

A. Contractor Name

B. Contract Number

C. Total Award Amount

D. Period of Performance

ANSWER:

The OWCP FECA Pharmacy Benefits Management (PBM) services procurement is a new requirement. As a result, there is no Incumbent Contractor.

2. QUESTION:

The Request for Proposal (RFP) indicates that the Government will award a single contract from the solicitation.

Given the size, geographic scope, and complexity of the proposed Pharmacy Benefits

Management Services contract, would the Government consider awarding more than one (1) contract from this solicitation to meet the requirements of the Office of Workers Compensation

Programs (OWCP)?

Reference: Solicitation Section M – Evaluation Factors for Award, Page 99 – Basis for Award.

ANSWER: The Government contemplates award of a single contract.

3. QUESTION:

How does the DOL plan to distinguish between transactions processed by the PBM versus transactions not processed through the PBM?

ANSWER: This will be a mandatory requirement for all FECA claimants. Section 5.1.2.4.6 of the contract requires the contractor to implement a process for reimbursing the Government for duplicate bill payments, monitoring network providers for billing outside of the network, and capturing information regarding provider billing outside of the network. Proposals should include a process for capturing prescription activity at unaffiliated network pharmacies, per

Section L, FAR 52.212-1 Addendum, Item 7(d)(i), Understanding of the Requirements, Utilization Management, Audits, and Reporting item d.

4. QUESTION:

The solicitation “Optional Contract Line Item Numbers (CLINs) for the following services:

Optional: Specialty Pharmacy Services

Optional: Patient Compliance Program

Optional: Disease Management Program

Does the Government require the Offeror to price these services in the solicitation?

If so, in what format?

Reference: Solicitation Section B - Schedule of Supplies / Services.

ANSWER: Offerors may price optional CLINS, but pricing of such CLINS shall not be considered for award purposes. The Government expects the Offeror to price these services by service type/unit attributed to individual claimant cases. Schedule B has been modified to allow

Offerors to propose appropriate service type/units for optional service CLINS.

5. QUESTION:

The solicitation indicates that the Contractor shall pay the provider directly and invoice the

Department of Labor (DOL).

Please respond to the following questions:

A. Is this only for transactions processed by the PBM, or for all pharmacy and DME transactions?

B. Is the PBM going to be adjudicating all pharmacy transactions for DFEC claimants versus the medical bill processor Contractor?

C. If the PBM is only adjudicating bills submitted by their network pharmacies using the PBM’s bin and group, and all pharmacies are required to use the DOL’s PBM bin and group, how will the DOL tell the difference between a bill adjudicated by their PBM versus all others?

D. If the PBM is responsible for adjudicating all pharmacy bills, is the PBM responsible for paying all pharmacies regardless of whether they are contracted with the PBM directly versus the

Treasury?

E. If the provider is not contracted with the PBM, what reimbursement rate is used to pay the pharmacy? Full FECA?

Reference: Solicitation Section 1.1 – Descriptions of Services/ Introduction, Page 14.

A. This is for all pharmacy transactions, which are mandatory, and those DME transactions where claimants voluntarily choose to use the PBM’s DME services.

B. Yes.

C. See response to question 3.

D. Yes.

E. The reimbursement rate shall be the rate awarded to the PBM under Schedule B of the resulting Contract.

6. QUESTION:

It appears that the solicitation only specifies DFEC covered Federal injured workers.

Will Energy, Black Lung, and Long Shore be included at any point?

Reference: Solicitation Section 1.2 – Background, Page 15.

ANSWER: The solicitation is specific to the FECA program. Other OWCP workers’ compensation programs are not covered under this solicitation or the resulting Contract.

7. QUESTION:

The solicitation requires that Contractors:

“Provide full prescription coverage for work-related injuries to all injured employees upon filing a FECA claim for traumatic injury.”

A. How does the Government know that a claim has been filed?

B. What happens if the claim is not accepted?

Reference: Solicitation Section 1.3 – Objectives, Page 15.

A. A claim form is received by DFEC.

B. Section L, FAR 52.212-1 Addendum, Item 7(d)(i), Understanding of the Requirement, Pharmacy Benefits Management item b. includes language that, if a workers’ compensation claim is denied by OWCP as not being compensable that (i) the Respondent will guarantee payment of any first fill prescriptions relative to the claim, (ii) that neither OWCP, nor the claimant shall be liable for the payment of the first fill pharmacy bills, and (iii) that the

Respondent will not seek reimbursement of the bills from either the pharmacy or the claimant.

8. QUESTION:

The following questions are submitted regarding Solicitation Section 1.4 – Scope (Page 15):

A. Are the services set forth in the Scope section (pharmacy benefits, diagnostic services, physical therapy and DME) the only services being solicited / required?

B. How does the PBM formulary differ from the treatment suites?

C. Will the formulary replace the treatment suites?

A. Yes; however, physical therapy is removed from the amended solicitation.

B. Treatment suites should not be a consideration in the Offeror’s proposal on formulary management

C. See response to question 8 item B.

9. QUESTION:

Does the beginning of the Base Period (June 29, 2018) signify the date of contract agreement or “go-live” date?

What does the Government consider the “implementation” start dates? Would the Government be willing to extend the implementation time period to twelve (12) months?

Reference: Solicitation Section 1.5 – Period of Performance, Page 15.

ANSWER: The solicitation has been amended to reflect a phased approach to implementation.

Implementation of Phase 1 must be completed within 60 days after contract award.

Implementation of Phase 2 must be completed within 90 days after contract award.

Implementation of Phase 3 must be completed within 180 days after contract award.

10. QUESTION:

Should net discount be based on AWP or FECA in Schedule B?

Reference: Solicitation Section 2.1.12 – Average Wholesale Price, Page 23.

ANSWER: The Respondent must provide a guaranteed discount from Average Wholesale Price

(AWP), as defined in Part 2 of this solicitation, which must be at or below the percentages given in Section L, FAR 52.212-1 Addendum, Item 2.A. Mandatory Criteria, Pricing/Discount.

11. QUESTION:

Are medications not processed through the PBM subject to treatment suite verification at POS and medications processed by the PBM subject to the PBM’s formulary?

Reference: Solicitation Section 5.1.3 – FORMULARY MANAGEMENT, Page 29.

ANSWER: It is noted that FORMULARY MANAGEMENT was moved to section 5.1.3.1 in the amended solicitation. All medications should be processed through the PBM. Once the formulary is implemented, all medications will be subject to verification through the PBM’s formulary.

12. QUESTION:

Solicitation Section 5.1.3.3.1 states that:

“Unless there is an exigent circumstance as determined by OWCP, the Contractor shall provide written notice of approved formulary changes to the home address of adversely impacted claimants, designated representatives, representative payees, prescribing physicians, and participating pharmacies no later than 45 days prior to the effective date of the change.”

A. Through what mechanism will the Government be providing the PBM the information on the

“designated representatives” and “representative payees”?

B. Will it be required to provide the mailing to everyone, or just those injured workers (and associated entities) that would be affected by the formulary change?

Reference: Solicitation Section 5.1.3.3.1, Page 29.

It is noted that section 5.1.3.3.1 was moved to section 5.1.3.1.3.1 in the amended solicitation.

A. The Government will provide necessary information and data on FECA cases and eligibility in order for the contractor to perform successfully.

B. The contractor shall provide written notice of approved formulary changes to the home address of adversely impacted claimants.

13. QUESTION:

How does the DOL plan to incorporate the mutually agreed upon MAC list into the program?

Reference: Solicitation Section 5.1.4.2, Page 30.

ANSWER: It is noted that section 5.1.4.2 was moved to section 5.1.2.5.2 in the amended solicitation. The Government will utilize the MAC to reconcile the differences between what may be an inflated AWP and the price that the PBM actually pays.

14. QUESTION:

Is a prior authorization required on all DAW1s?

Reference: Solicitation Section 5.1.5.4, Page 30.

ANSWER: It is noted that section 5.1.5.4 was moved to section 5.1.4.4.4 in the amended solicitation. The PBM’s prior authorization process may be utilized for specific DAW1s upon

OWCP’s request.

15. QUESTION:

Solicitation Section 5.1.5.4.1 states the following:

“The Contractor shall provide physician outreach, such as “academic detailing”, when potential claimant safety concerns with prescribed drugs are noted in order to encourage safe prescribing practices.”

Are letters sufficient to fulfill this request, or is telephonic communication required for these functions?

Reference: Solicitation Section 5.1.5.4.1, Page 30.

ANSWER: It is noted that section 5.1.5.4.1 was moved to section 5.1.4.4.4.1 in the amended solicitation. Offerors should provide a proposal that includes all appropriate communication methods based on standard industry practices for the type of outreach provided.

16. QUESTION:

Solicitation Section 5.1.6.1 states the following:

“The Contractor shall ensure that all claimants within the Continental United States

(CONUS) and its permanently inhabited territories, and outside the Continental United

States (OCONUS), are able to obtain prescribed DME quickly (within two calendar days) and conveniently (within a one-hour drive).”

A. What specific geographic areas outside the continental United States will these services be provided?

B. What is the annual volume of items shipped outside of the continental United States?

C. For OCONUS – is it a requirement for the same pricing schedule to be applied across all territories?

D. If OCONUS, are overnight charges applicable.

Reference: Solicitation Section 5.1.6.1, Page 30.

It is noted that section 5.1.6.1 was moved to section 5.1.4.5.1 in the amended solicitation.

A. FECA claimants may reside in countries throughout the world.

B. We are unable to provide this information; however, there are approximately 16,937 claimants residing outside of the Continental United States (OCONUS) at this time, of which only approximately 1,460 are adjudicated cases, and of which roughly 60% reside in Puerto

Rico.

C. No, it is not a requirement for the same pricing schedule to be applied across all territories.

D. Net discount pricing proposed by the Offeror for DME shall include all costs of services to provide DME.

17. QUESTION:

The solicitation indicates that high value medical equipment that is no longer needed by a claimant has to be retrieved.

Does the Government require that the Contractor bank the equipment, and refurbish and re-use with other injured workers requiring same equipment?

Reference: Solicitation Section 5.1.6.6.3, Page 31.

ANSWER: It is noted that section 5.1.6.6.3 was moved to section 5.1.4.5.6.3 in the amended solicitation. The Government requires a retrieval and/or refurbishing process for equipment, that includes a credit to the Government associated with the claimant and specific case for which the medical equipment was purchased.

18. QUESTION:

Would the Government consider providing the list of claim status indicators?

Reference: Solicitation Section 5.1.10.10, Page 34.

ANSWER: It is noted that section 5.1.10.10 was moved to section 5.1.2.4.10 in the amended solicitation. This information is available on page 10 of the document that is located at:

https://www.dol.gov/owcp/dfec/regs/compliance/dfecdd/NewCaseDataExtractFileLayout.pdf https://www.dol.gov/owcp/dfec/regs/compliance/dfecdd/NewCaseDataExtractFileLayout.pdf

19. QUESTION:

Technical Exhibit 3 of the Solicitation provides the following Estimated Workload Data:

ITEM

NAME

ESTIMATED QUANTITY

1 Number of Federal employees (as of November 30, 2017) 2.7 million n/a

2 Active managed workers’ compensation cases (as of

November 30, 2017) 220,707 n/a

3 Number and cost of prescriptions generated by actively managed cases (as of November 30, 2017) 911,131 $235,685,753

A. How many ancillary orders were provided in that timeframe?

B. What is the breakdown of volume of services that are CONUS versus OCONUS?

Reference: Technical Exhibit 3, Page 54.

A. Ancillary orders are interpreted to mean diagnostic tests. The solicitation is amended at

Technical Exhibit 3 to reflect $54,000,000 in diagnostic services spending as of

September 30, 2017.

B. It is not possible to provide a further breakdown of the volumes.

20. QUESTION:

What is the Government e-mail size limit (in megabytes (MB)) for receiving files / proposal information?

The Government size limit for receiving a file is 20MB. However, please note that the file attachment size may increase by up to 30% depending on the Offeror’s e-mail system. As a result, a file larger than 20MB may be sent via e-mail.

21. QUESTION:

Solicitation Section L – GEOGRAPHIC ABILITY AND AVAILABILITY (Page 94) requires the following:

A. A list of the major chains your firm does business with, grouped by State and territory.

(reference 5.1.2.1.1)

B. The total number of pharmacies in network, grouped by State and territory. (reference

5.1.2.1.1)

C. Identify all mail order pharmacy(ies) that will provide service. (reference 5.1.2.3)

D. The total number of network providers for DME and Medical Imagining Facilities, grouped by State and territory (reference 5.1.6.1)

Items a, b, and d listed above are all to be grouped by State/territory. As a result, these lists may be very long (especially the first list, which could be hundreds of pages).

Please confirm that all four (4) lists are exempt from the page limit.

Reference: Solicitation Section L – GEOGRAPHIC ABILITY AND AVAILABILITY, Page

94.

ANSWER: It is noted that the references under GEOGRAPHIC ABILITY AND

AVAILABILITY are changed in the amended solicitation to: A) 5.1.2.1.1.1; B) 5.1.2.1.1.1; C)

5.1.2.1.3; and D) 5.1.4.5.1. Section L, FAR 52.212-1 Addendum, Item 7(c) Page Count, states that Volume 1 is NTE 50 pages, excluding (emphasis added): the QCP, resumes, covers, title pages, executive summaries, table of contents, corporate experience, Start-up Plan Phase-out-

Plan, lists of network providers, and supporting documentation.

22. QUESTION:

Solicitation Section L – Utilization Management, Audits, and Reporting (Page 95) requires

Offerors to:

“Define your methodology for determination of cost savings to OWCP (without detailing price proposal information) (reference 5.1.5)”

“Describe how you plan to substitute generic for brand when allowable. (reference

5.1.5.1)”

However, Section 5.1.5 and Section 5.1.5.1 of the Performance Work Statement (PWS) refers to the DUR program, and does not appear to be relevant to the requirements listed above.

Can the Government confirm whether Section 5.1.5 and Section 5.1.5.1 are the correct PWS references for these areas?

Reference: Solicitation Section L – Utilization Management, Audits, and Reporting, Page 95.

ANSWER: It is noted that the references under UTILIZATION MANAGEMENT, AUDITS, AND REPORTING are corrected in the amended solicitation as follows:

Define your methodology for determination of cost savings to OWCP (without detailing price proposal information (reference 5.1.2.7.3.ee)

Describe how you plan to substitute generic for brand when allowable. (reference

5.1.4.4.1.h)

23. QUESTION:

Can the Government confirm whether the three (3) required resumes are not part of the five (5) page limit?

ANSWER: Section L, FAR 52.212-1 Addendum, Item 7(c) Page Count, states that Volume 1 is NTE 50 pages, excluding (emphasis added): the QCP, resumes, covers, title pages, executive summaries, table of contents, corporate experience, Start-up Plan Phase-out-Plan, lists of network providers, and supporting documentation.

24. QUESTION:

Solicitation Section L – Volume III – Price/Discount (Page 97) references: “minimum requirements at Section 5.1.4.4.”

However, Section 5.1.4.4 is not contained in the solicitation.

Can the Government confirm whether Section 5.1.4.4 is the correct reference?

Reference: Solicitation Section L – Volume III – Price/Discount, Page 97.

ANSWER: The amended solicitation corrects the reference under Solicitation Section L –

Volume III – Price/Discount to reflect Section L, FAR 52.212-1 Addendum, Item 2.A, Pricing/Discount.

25. QUESTION:

Solicitation Section M – Evaluation Factors for Award / Evaluation Factor I (Page 99) states in part that:

“The Government will evaluate the offeror’s understanding of the work to be performed in accordance with Part 5 of the PWS and responses to the items laid out in the FAR

52.212-1 ADDENDUM at 4(d) (i).”

However, Addendum Section 4(d) (i) is not contained in the solicitation.

A. Can the Government confirm whether Addendum Section 4(d) (i) is the correct reference?

B. Section L does not outline all of Part 5 from the solicitation. Would the Government consider revising Section L to identify all of Part 5 that the Offeror is required to address in the proposal?

Reference: Solicitation Section M – Evaluation Factors for Award / Evaluation Factor I, Page

99.

A. The solicitation is amended to remove “at 4(d) (i) from “Factor I – Technical, Understanding of the Requirement”.

B. Section L has been modified to include all of Part 5.

26. QUESTION:

Subject: RFP No. 1605DC-18-R-00020

Reference: RFP Section _1.2__, Paragraph(s) _2___, Page(s) _14___.

This paragraph states prescription costs were $235,685,753. Can you confirm the total dollar spend for DME? If so, can you further segment spend for Diagnostics, vs PT, vs all other DME spend (i.e. equipment/supplies)?

ANSWER: The solicitation is amended at Technical Exhibit 3 to reflect $37,462,205 in DME spending as of October 31, 2017, and $54,000,000 in diagnostic services spending as of

September 30, 2017. Physical therapy is removed from the amended solicitation.

27. QUESTION:

Reference: RFP Section _1.6.11.1__, Paragraph(s) _1 & 2___, Page(s) _20___.

Would you consider accepting 10 to 15 years WC Pharmacy benefit Management experience in lieu of a Bachelor’s degree for the PM or AM positions?

ANSWER: Yes, Section 1.6.11.1 has been revised to indicate that a bachelor’s degree is preferred

28. QUESTION:

Reference: RFP Section _1.4__, Paragraph(s) _1___, Page(s) __15__.

The Scope explains the Contractor shall implement and operate a PBM in the United States and its territories for the Division of Federal Employees’ Compensation Programs (DFEC) that injured federal employees will generally be required to use in order to access pharmacy benefits.

It further defines PBM as including DME, but in other sections of the RFP states the use of DME will be voluntary. Can you confirm that PBM will be generally required to be used, but that

DME will be used voluntarily?

ANSWER: Correct, see response to question 5.A.

29. QUESTION:

Reference: RFP Section C - Description/Specifications ___, Paragraph(s) _ 1.6.7.4.4 ___, Page(s) _18__.

Do internal employees of our company need to have a PIV card or is the language simply suggesting that we need to support the PIV certificate store for cross-network traffic? If so, we presume this is because an added level of data will be supplied to the PBM requiring PIV access standards. Please confirm.

ANSWER: Any internal staff that have access to the server on which the data resides (e.g.

System Admins, Database administrators) or who access the data will need PIV cards. They will be issued by DOL, but the system will need to use them to authenticate the users.

30. QUESTION:

Reference: RFP Section 5.1.8 CUSTOMER SUPPORT ___, Paragraph(s) 5.1.8.2.1 ___, Page(s) _32__.

There is mention of a web portal hosted on a .gov domain. Does that mean our web application will need to be hosted on government servers within the domain or is that language referencing a single-sign on solution will be necessary to redirect government administrators to our web portal from within the .gov domain?

ANSWER: It is noted that the web portal requirement in section 5.1.8.2 was moved to section

5.1.4.2 in the amended solicitation. The requirement is for a redirect to the vendor’s web portal from within the .gov domain.

31. QUESTION:

Reference: RFP Section _ C - Description/Specifications__, Paragraph(s) _Item 1.2

Background___, Page(s) _14___.

Since the claims examiner retains the need to determine the accepted condition and authorization of certain medical treatments, we understand that OWCP will require a continued use of their central bill processing (CBP) system. Today, drug lists and adjudication rules reside within

CBP/X2. Is it OWCP’s expectation that those be replicated in the PBM system, or will OWCP expect that the PBM to assume the function of applying drug list and adjudication rules and only escalating certain bills to examiner for further review and approval?

If CBP/X2 will be utilized, can you explain in what capacity or are you willing to consider the

PBM’s recommendations for those functions whose performance do not require escalation to the examiner?

Will the selected PBM be able to set up routine billing files for payment purposes?

ANSWER: Section 5.1.3.1.5 of the amended solicitation addresses the requirement for the

Contractor to provide the ability to deny or refer for OWCP approval payment of medications based on an OWCP-specified dollar threshold, specific medication (e.g., NDCs), provider, or other criteria (e.g., case).

Section 5.1.4.1 of the amended solicitation describes the requirement for a Contractor to implement a user interface (UI) to transmit pharmacy authorization requests (prior authorization or otherwise as specified by OWCP) and messaging to DOL that provides recommendations

(e.g., recommend step therapy, recommend approval, recommend denial) on drug authorization, based on evidence-based best practice. The Offeror’s proposal should discuss your best approach to performing the work.

The requirement for payment files has been removed from the solicitation.

32. QUESTION:

Reference: RFP Section _1.6.7.4.5_, Paragraph(s) __1 __, Page(s) _18

Regarding the Contractor requiring the use of a DOL-issued PIV card for logical access by

Contractor and DOL employees to the PBM system and to data hosted by that system, is this requirement specific to Contractor and DOL employees that are external to the PBM, or will internal employees of the PBM that will be working to support the OWCP program also required to use a PIV card?

ANSWER: See response to question 29.

33. QUESTION:

Reference: RFP Section _5.1.3.2 & 5.1.5.3_, Paragraph(s) __1 & 1 __, Page(s) _29 and 30

With regard to Formulary Development and DUR is the OWCP requirement that the formulary, formulary parameters and DUR edits are stored and maintained in the medical bill processing system “X2”. Currently pharmacy transactions are sent to “X2” for adjudication decisions. Will the PBM be able to store and maintain the formulary, formulary parameters and DUR edits using our existing PBM systems to supply real-time adjudication decisions (Paid/Denied or messaging that indicates some type of authorization needs to be submitted by the Pharmacy or Provider)?

If awarded, will OWCP consider Contractor recommendations regarding where functions are stored? It is understood that certain functions must reside with claims examiner and also within bill processing system.

ANSWER: It is noted that sections 5.1.3.2 and 5.1.5.3 were moved to sections 5.1.3.1.2 and

5.1.4.4.3, respectively, in the amended solicitation. The Offeror’s proposal should discuss your best approach to performing the work.

34. QUESTION:

Reference: RFP Section _5.1.10.2 & 5.1.10.8_, Paragraph(s) __1 & 1 __, Page(s) _33

5.1.10.2 states that the Contractor shall submit files electronically to OWCP at point of sale while, 5.1.10.8 states the Contractor shall provide a weekly update of PBM bill history and transaction file data in the medical bill system and/or to OWCP. How is the weekly update of

PBM bill history and transaction file data different from the billing data sent at point of sale?

ANSWER: It is noted that sections 5.1.10.2 and 5.1.10.8 were moved to sections 5.1.2.4.2 and

5.1.2.4.8, respectively, in the amended solicitation. Section 5.1.2.4.2 relates to individual point of sale prescription information and bills; whereas, Section 5.1.2.4.8 relates to a history file of all bill transactions that occurred. Section 5.1.2.4.8 was also amended to a daily update.

35. QUESTION:

Reference: RFP Section _5.1.10.11 _, Paragraph(s) __1 __, Page(s) _34

This section infers that there may be multiple systems for which near real-time interfaces would need to be built to secure and update claimant authorizations.

Are there multiple systems that would need to be interfaced, or is it just a centralized OWCP program case management system?

Can the Government provide the number of and name of systems OWCP anticipates integration with?

ANSWER: It is noted that section 5.1.10.11 was moved to section 5.1.4.3 in the amended solicitation, and revised as follows:

Authorization. The contractor shall obtain existing claimant authorizations for covered services prior to implementation of Phase 3, from OWCP or its central bill process contractor.

While DFEC has a single case management system, it is anticipated that the Offeror may be required to interface with multiple systems including the central bill processing contractor’s system. As stated in section 5.1.4.1 of the amended solicitation, the contractor shall also implement a user interface (UI) to transmit pharmacy authorization requests (prior authorization or otherwise as specified by OWCP) and messaging to DOL.

36. QUESTION:

Reference: RFP Section _5.1.11.2.2 _, Paragraph(s) __1 __, Page(s) _35

What is the rational to validate the FECA program eligibility and authorization database monthly if near real-time interfaces are setup to constantly pass both claimant eligibility and authorization data updates? Is this for a validation check, or is this Finance related that is being interpreted incorrectly, as it does fall under the broader 5.1.11 EFT Enrollment Checks?

ANSWER: Section 5.1.11.2.2 is removed from the amended solicitation.

37. QUESTION:

Reference: RFP Section _5.1.3.2_, Paragraph(s) __3__, Page(s) _29_.

The statement: Formulary Development. The Contractor shall recommend, develop and maintain a formulary and formulary parameters (e.g., prior authorization, step therapy, quantity limits, initial treatment of acute pain and initial/ongoing treatment of chronic pain with opioids), which decrease program costs and improve patient outcomes. The formulary and formulary parameters must be approved by OWCP.

To ensure a smooth transition with minimal disruption to patients:

1. We would like to discuss thoroughly the formulary and its requirements if awarded the program. We are concerned about making sure transition timeframe for the implementation of the agreed formulary is sufficient.

Will you consider Contractor recommendations for conversion timeframe to convert to new or modified formulary to be certain all aspects are considered and formulated for best injured Federal worker benefit?

2. Is there a preference for the new formulary be phased in? For example, all legacy would be grandfathered while new claims be subject to the new formulary. Will you consider Contractor recommendations?

ANSWER: It is noted that section 5.1.3.2 was moved to section 5.1.3.1.2 in the amended solicitation. The Government will consider the Offeror’s approach to meeting the requirements of the PWS.

38. QUESTION:

Reference: RFP Section _5.1.4.2_, Paragraph(s) __1__, Page(s) _30_.

The statement: The Contractor shall establish a maximum allowable cost (MAC) list for generic products agreed upon by OWCP. The Contractor and OWCP shall agree on a standardized definition of “brand” vs. “generic” drug.

1. What fields (drug name, price, quantity, etc.) should MAC list contain?

2. If Contractor definition of brand versus generic drug differ, will OWCP and/or central bill processing entity share the database utilized, clinical and technical criteria used so that an agreement on definition can be achieved?

solicitation.

1. The Offeror’s proposal should document your best approach to establish a MAC list and the data fields necessary, based on industry standards.

2. The Offeror’s proposal shall provide your standardized definition of “brand” and “generic” medications. Upon award of the Contract, the Government will work with the Contractor to approve or discuss changes to the definitions.

39. QUESTION:

Reference: RFP Section _5.1.4.2_, Paragraph(s) __1__, Page(s) _30_.

The statement: Edits must include, but shall not be limited to drug-drug interactions, drug-allergy contraindications, drug-pregnancy contraindications, therapeutic duplication, refill too soon, incorrect dosage, quantity limits, morphine milligram equivalents (MME) per day, step therapy edits, and other situations that may endanger the health and welfare of claimants. Edits must also notify the pharmacist to obtain prior authorization for non-formulary medications, compounded drugs, opioids, and brand name medications when generic equivalents are available.

1. What is the MED threshold OWCP will require for an opioid to reject at (50, 90, 100, other)?

2. Will OWCP share all criteria requirements to generate prior authorization during an implementation planning phase if there are others besides those listed below? Is OWCP willing to accept recommendations from Contractor regarding prior authorization items?

a. non-formulary medications,

b. compounded drugs,

c. opioids,

d. brand name medications when generic equivalents are available

3. Based on prior authorization (PA) rules, will OWCP allow or consider Contractor recommendations regarding what level to escalate the PA to (i.e., Clinical vs claims examiner) after the dispensing pharmacist receives the prompt to obtain a PA?

a. Compound and opioid drugs requires letter of medical necessity (LMN) to be reviewed. Please confirm whether your intent is for district medical staff to review the recommendation made by Contractor PA clinician prior to adjudication.

b. Non-formulary and brand drugs should be triaged and reviewed by whom? Do you have a requirement or will you consider Contractor recommendations?

c. How should other PA reject be handled?—i.e., auto denial at POS? Example:

i. Refill too soon reject

ii. Duplicate therapy reject

iii. Dollar threshold reject

1. DFEC policies dictating requirements for edits and/or prior authorizations (PAs) are not static and constantly changing. Current requirements will be shared with the vendor at time of award and where changes are made or new edits/PAs are added, those will be communicated to the award recipient.

2. The Government will consider the Offeror’s approach to meeting the requirements of the PWS.

3. See response to question 39 item 2.

40. QUESTION:

Reference: RFP Section _1.6_, Paragraph(s) __1__, Page(s) _41_.

The statement: Complete implementation of the Basic Services outlined in Section 5.1 of this

PWS. Implementation completed within 60 days after contract award.

If all of the primary objectives noted in section 1.3 can be met within the required 60-day timeframe, is OWCP willing to consider alternate timeframes for each of the additional requirements in Section 5.1 based on industry specific logical sequencing of implementations to achieve maximum performance and outcomes for utilization review functions for the injured worker, as an example?

ANSWER: See response to question 9.

41. QUESTION:

Reference: RFP Section L - Instructions, Conditions, and Notices to Bidders, Paragraph(s):

Section 6. Submission of Solicitation Questions, Page(s): 91 of 100.

The RFP notes that questions and comments on the RFP are due by 1:00 p.m. ET on April 26.

Please advise when responses to bidder questions will be shared with bidders and that the timing of responses will be sufficient to allow bidders to adjust their responses accordingly.

ANSWER: The responses to RFP questions are provided in this document.

42. QUESTION:

Section 6. Submission of Solicitation Questions, Page(s) 91 of 100.

The May 11 due date for responses allows offerors only 14 business days to assess, price, and build a competitive proposal offering. Given the complexity of this proposal, this short turnaround time is likely to be exceedingly challenging for all offerors and may dissuade qualified and exceptional offerors from bidding, which is not in the Government’s interest.

The Government would benefit from allowing offerors more time to prepare proposals as it would likely increase competition, which drives prices lower, and the Government would receive much higher quality proposals. Would the Government be willing to extend the proposal due date to 90 days from RFP issuance?

ANSWER: The solicitation is amended to reflect a proposal due date of May 21, 2018.

43. QUESTION:

Section A. Pricing/Discount Tables, Page(s): 90 of 100.

We observe that there is no incentive provision in the RFP for the offeror to beat or exceed the pricing guarantees put forth in the contract. The Government would benefit by inserting such a requirement because it incentivizes offerors to achieve savings for the Government in excess of the guaranteed discounts. Absent such a requirement, the Government may be missing a material amount of savings.

ANSWER: Please refer to Schedule B of the RFP.

44. QUESTION:

Reference: RFP Section M - Evaluation Factors for Award, Paragraph(s): ADDENDUM

TO 52.212-2, Basis for Award, Page(s) 99-100 of 100.

Please provide further guidance on the overall evaluation criteria. What is the hierarchy of importance for bidder selection? Is there a weighting score for each factor? Factor 1 is significantly more important than Factor 2 (Past Performance) and Factor 3 (Price). Both Factor

1 and Factor 2 combined are greater than Factor 3, but Factor 1 alone is greater than Factor 3. Is

Factor 2 (Past Performance) more important than Factor 3 (Price)?

Recognizing the size of this RFP, are you most interested in evaluating complexity and scope rather than dollar value when evaluating past performance?

Please also advise how the Optional Clinical Programs (Specialty Pharmacy Services, Patient

Compliance Program, and Disease Management Program) will factor into the evaluation.

Is there any chance the Optional Clinical programs will be exercised before 6/28/2019?

ANSWER: As indicated in the Basis for Award, The Government will award a single contract from this solicitation to the responsible offeror whose offer conforming to the solicitation is most advantageous to the Government based on the best overall proposal that is determined to be the most beneficial to the Government, with appropriate consideration given to the three evaluation factors: (Technical, Past Performance, and Price/Discount).

The solicitation has been amended to reflect the following order of importance (change underlined below for ease of reference):

1. The Factor I, Technical is significantly more important than Factor II, Past

Performance and Price/Discount.

2. The Technical Factor is significantly more important than the Price/Discount

Factor.

3. The Past Performance Factor is more important than Price/Discount.

4. All non-Price/Discount factors when combined, are significantly more important than Price/Discount.

The Government will evaluate past performance of 3 current or previous (within the last 3 years) contracts for relevancy (within the last 3 years) based on how well the contractor performed on projects of similar dollar value, scope, and complexity.

The Government will evaluate quotes for award purposes based on the CLIN prices/discounts for basic services, including all option periods.

In regard to optional CLINS, the Government anticipates that optional services would begin no earlier than the second contract year (also known as Option Year 1).

45. QUESTION:

Reference: J - List of Documents, Exhibits and Other Attachments, Paragraph(s):

Attachment 1 – Past Performance Questionnaire Form, Page(s): 69 of 100.

The RFP requests bidders provide information on past performance of three current or previous contracts using the Past Performance Questionnaire Form. Since we are unable to ensure our clients will submit the requested form to the Contracting Officer in the format and within the timing requested, are bidders able to request past performance questionnaires from more than three clients?

Asking clients to provide past performance questionnaire responses can be an imposition on their time and often takes 3+ weeks to coordinate the response. Will you be willing to accept questionnaire responses 2 weeks after the final RFP response?

ANSWER: Offerors are able to request Past Performance on the questionnaire from more than three current or previous contracts; however, the Government will only review and evaluate the first three Past Performance Questionnaire Forms received. The Government will accept Past

Performance Questionnaires up to 1 week after the final RFP due date.

46. QUESTION:

Reference: RFP Section: Section C - Description/Specifications, Part 5, Specific Tasks, Paragraph(s): Section 5.1.3.3.1 and 5.1.3.3.3, Page(s) 29 of 100.

For Section 5.1.3.3.1 – Does written notice include email and fax? For Section 5.1.3.3.3 – Does written notice only include correspondence delivered by the post office?

ANSWER: It is noted that sections 5.1.3.3.1 and 5.1.3.3.3 were moved to sections 5.1.3.1.3.1 and 5.1.3.1.3.3, respectively, in the amended solicitation. For injured workers, and until otherwise specified, written notice must be provided through the United States Postal Service

(USPS). Electronic notifications are permissible for prescribing physicians and participating pharmacies, since both will be electronically enrolled with either the PBM or the central bill processing contractor. Electronic communications containing confidential information and/or

PII must comply with the Privacy Act and security requirements.

47. QUESTION:

Paragraph(s): Section 5.1.13.2, Page(s) 36 of 100.

Section 5.1.13.2 states “Required reports, in a format to be developed by the Contractor and agreed to by OWCP, include but are not limited to…”

Is the Government able to provide guidance to all offerors as to the number of reports over and above the 30 that are already in the RFP that may be expected during the term of the contract?

This information is necessary so that all offerors may accurately price their offering.

ANSWER: It is noted that section 5.1.13.2 was revised and moved to sections 5.1.2.7.2 and

5.1.2.7.3 in the amended solicitation. Section 5.1.2.7.3 specifies the standard reports that the contractor shall provide. Section 5.1.2.7.2 requires additional ad hoc reporting capability via an internet-based reporting tool.

48. QUESTION:

Reference: RFP Section: Section C - Description/Specifications, Part 6, Applicable

Publications, Paragraph(s) J, K, N, O, P, R, Page(s) 39 and 40 of 100.

The RFP references National Institute of Standards and Technology (NIST). The NIST requirements in the RFP will cost Contractors millions dollars to implement, which drives up the

Government’s costs.

Is there an alternative security standard that the Government would consider in lieu of NIST?

ANSWER: No, NIST is the standard that the US Government is held to, and to which all other

OWCP contracts are held.

49. QUESTION:

Paragraph(s): Section 5.1.3.4, Page(s) 29 of 100.

Will the DOL provide the specs for the user interface to transmit messaging to the DOL? Is there a system or approach that will be defined or does the offeror propose a process?

ANSWER: It is noted that section 5.1.3.4 was revised and moved to section 5.1.4.1 in the amended solicitation. The Offeror’s proposal should discuss your best approach to performing the work securely, considering the data to be transmitted (e.g. PII, confidential information).

50. QUESTION:

Paragraph(s): Section 5.1.4.2, Page(s) 30 of 100.

Please provide the agreed upon definition of “brand” and “generic” drugs per the current contract.

ANSWER: See response to question 1. It is noted that section 5.1.4.2 was moved to section

5.1.2.5.2 in the amended solicitation.

51. QUESTION:

Paragraph(s): Section 5.1.5.3, Page(s) 30 of 100.

Please provide details on the trigger points for the morphine milligram equivalents (MME) that trigger DUR alerts.

ANSWER: It is noted that section 5.1.5.3 was moved to section 5.1.4.4.3 in the amended solicitation. The Offeror’s proposal should discuss your best approach to performing the work.

52. QUESTION:

Reference: Section C - Description/Specifications, RFP Section: Part 5, Specific Tasks, Paragraph(s): Section 5.1.9.2, Page(s) 33 of 100.

What standard is currently being used to determine if the Contractor is increasing network provider availability?

ANSWER: See response to question 1. It is noted that section 5.1.9.2 was moved to section

5.1.2.3.2 in the amended solicitation.

53. QUESTION:

Paragraph(s): Section 5.1.6.3, Page(s) 31 of 100.

What is OWCPs desired timeframe for accurate and timely responses to inquiries/requests?

ANSWER: It is noted that section 5.1.6.3 was moved to section 5.1.4.5.3 in the amended solicitation. The requirement was also changed to reflect a response time of 2 business days.

54. QUESTION:

Paragraph(s): Section 5.1.10, Page(s) 33-34 of 100.

How will eligibility information be provided to the Contractor?

ANSWER: It is noted that section 5.1.10 was moved to section 5.1.2.4 in the amended solicitation. Section 5.1.2.4.10 states that eligibility files will be provided by OWCP. The

Offeror shall propose their best approach to implement data interfaces to obtain those files in accordance with this section.

55. QUESTION:

Paragraph(s): Section 5.1.12 - Fraud, Waste, and Abuse Monitoring, Page(s) 35-36 of 100.

How many fraud cases have been referred by the current Contractor between Nov 30, 2016 and

Nov 30, 2017?

ANSWER: See response to question 1. It is noted that section 5.1.12 was moved to section

5.1.2.6 in the amended solicitation.

56. QUESTION:

Reference: RFP Section: Section C - Description/Specifications, Paragraph(s): Section 1.2

Background, Page(s) 14-15 of 100.

Section 1.2 highlights the number of cases and volume of prescriptions. Please provide a claims data file with the latest 12 months of data at the NDC level with detailed NABP information to allow bidders to identify the details of the claims and locations of dispensing activity in order to facilitate our financial offer.

ANSWER: The solicitation is amended to provide Attachment 3 Pharmacy Transaction Data for the period of May 2017 through April 2018. The data includes all pharmacy transactions excluding reversals. Data fields include a unique case file identifier, claimant year of birth, claimant year of injury, date drug dispensed, state in which dispensed, drug name, and quantity dispensed.

57. QUESTION:

Reference: Section C - Description/Specifications, RFP Section: Part 3, Specific Tasks, Paragraph(s): Section 3.1.2, Page(s) 26 of 100.

What are the types of instances / activities in the past that have required contract staff to work onsite at a Federal facility?

ANSWER: The place of performance is the contractor facility, but there may be instances where face-to-face meetings are necessary at a Federal facility.

58. QUESTION:

Reference: RFP Section: Section B – Schedule of Supplies/Services, Paragraph(s): Net

Discount Proposed, Page(s) 9 of 100.

Please provide clarification around pricing expectations for DME (e.g., tests, x-ray, medical, radiology, exam, transportation, language, speech therapy, etc.).

What other services are included in DME?

Is the pricing expected to vary by region or complexity, or should the offeror offer one price?

ANSWER: The Offeror’s proposal shall provide the best approach to provide DME services, and establish a pricing model. Net discount pricing proposed by the Offeror for DME shall include all costs of services to provide DME.

59. QUESTION:

Reference: RFP Section L - Instructions, Conditions, and Notices to Bidders, Paragraph(s)

Section 7. Proposal Submission, Page(s) 94 of 100.

Per the “Understanding of the Requirement” bidders are required to demonstrate that they can perform the work described in Part 5.1 of the Performance Work Statement (PWS) on Pages 14 through 21 of the RFP. Please advise where bidders should provide any potential deviations/explanations for the requested requirements.

ANSWER: Volume I, Technical Approach, states that the Offeror’s technical narrative should discuss its understanding of the requirements of this acquisition and its approach to performing the work, including any potential deviations/explanations.

60. QUESTION:

Reference: RFP Background, Page 15.

The solicitation indicates that: "There are two groups of federal civilian employees eligible for coverage under this program."

In order to provide the most accurate pricing, will the government please consider providing the last 12 - 24 months of claims for your population. It is a good proxy of what we should expect in the future from a drug mix and volumes. Data should be de-identified with the exception of identifying all drugs taken by each individual. This will help with clinical estimates too.

ANSWER: See response to question 56.

61. QUESTION:

Reference: Sections – Multiple, Paragraphs 3.1.1, 5.1.10.4, 5.1.11.2.2, Pages 26, 33, 35

The PBM standard used by 99+% of our clients is to send eligibility file updates to us daily.

This is the most reliable and road tested way to update eligibility. We can provide a standard

NCPDP file format as our recommendation.

Real-time eligibility would open security risks for both organizations, require significant investment up-front and ongoing support which is error prone. Government systems will need to respond in 1 - 2 seconds or the adjudication will fail. Claims are processed at retail 7 x 24 with the exception of Sundays from midnight - 3am when we perform system maintenance.

Contractors will need government system up at these times to support real-time adjudication. If eligibility must be done in real-time, than we strongly recommend not requiring the following data to be pulled during real-time adjudication: authorization, coverage, excluded provider, on-notice providers, etc. Will the government consider making this change?

This often leads to adjudication errors due to system availability, slow access times, technical problems, etc.

ANSWER: Section 5.1.10.4 was moved to section 5.1.4.1.1 in the amended solicitation, and revised as follows:

The contractor shall coordinate with the central bill process contractor, and implement interfaces where necessary.

Section 5.1.11.2.2 was removed from the amended solicitation. Section 5.1.2.4.10 of the amended solicitation was changed to reflect a daily update requirement.

62. QUESTION:

Reference: Paragraph 5.1.13.2, Page 36

Please consider providing examples or brief descriptions of the details DOL would like to receive within the outlined reports.

ANSWER: See response to question 47. The Offeror’s proposal shall describe its best approach to providing the listed standard reports, and data to create accurate and timely financial and statistical reports regarding prescription processing, participant services, network adequacy, patient management, and drug utilization.

63. QUESTION:

Reference: SF 1449 Section Box 8, Paragraphs 5/11/2018 RFP due date, Page 1

The prior RFI had great high level key benefit and services elements of the desired RFP but did not have any of the detail, specificity, context, or IT requirements for potential bidders to consider. The 8 page RFI from 2017 has evolved with the details industry needs to respond on all fronts.

A huge amount of detail has been added which drives the need for solutions and costing. Would the Government consider extending the deadline to 3 months, 8/11/2018 to allow for competitive responses and level the playing field for all?

ANSWER: See the response to question 42.

64. QUESTION:

Reference: Section Referenced fee schedule, Paragraph Pharmacy section, Pages 2 - 3

The fee schedule calls out a dispensing fee with each prescription, which is a PBM industry norm. A CLIN for dispensing fee per claim is not found in the RFP. Will you consider adding this vitally important dispensing fee CLIN? If not, where should we provide the costs in our proposal?

ANSWER: Net discount pricing proposed by the Offeror in Schedule B shall include all costs of services to provide these services.

65. QUESTION:

Reference: Section PRIVACY RESPONSIBILITIES, Paragraphs All of 1.6.7.3, Pages 16

– 19

IT security requirements called out on these pages are extensive. From our experience, FISMA was considered by the VA in recent procurements and abandoned in lieu of SOC 2. Would the government consider removing FISMA and adding SOC 2 with 5 trust principles instead?

Would you consider SOC 2 to meet your FISMA requirement? Also, due to the lengthy time required to implement new IT security standards would you consider a phased in IT security schedule so the Government program can start sooner and IT security requirements are added over the first two (2) years?

ANSWER: The Government will have to issue an Authority to Operate for the system before it can be used.